N312 Urinary Elimination Handout PDF

URINARY ELIMINATION ELLEN STEIDL, MS, RN, CCRN N312 PATHOPHYSIOLOGY I UNIVERSITY OF NORTH DAKOTA  IDENTIFY COMMON MINERALS PRESENT AND CLINICAL MANIFESTATIONS IN URINARY LEARNIN STONES. DESCRIBE THE COMMON ORGANISMS CAUSING URINARY TRACT INFECTIONS (UTI)....

URINARY ELIMINATION ELLEN STEIDL, MS, RN, CCRN N312 PATHOPHYSIOLOGY I UNIVERSITY OF NORTH DAKOTA  IDENTIFY COMMON MINERALS PRESENT AND CLINICAL MANIFESTATIONS IN URINARY LEARNIN STONES. DESCRIBE THE COMMON ORGANISMS CAUSING URINARY TRACT INFECTIONS (UTI). G COMPARE CYSTITIS, ACUTE PYELONEPHRITIS, AND CHRONIC PYELONEPHRITIS. DEFINE UREMIA AND AZOTEMIA. OBJECTIV REVIEW STRUCTURE AND FUNCTION OF THE UROLOGIC SYSTEMS. COMPARE AND CONTRAST CHANGES TO THE URINARY SYSTEM ACROSS THE ES LIFESPAN. DESCRIBE THE DIFFERENCES BETWEEN TYPES OF URINARY INCONTINENCE. REQUIRE NORRIS, T. L. (2020). PORTH’S ESSENTIALS OF PATHOPHYSIOLOGY (5TH ED.). WOLTERS KLUWER. D CHAPTER 35:908-911, 916-919 READING CHAPTER 33: 868-875 URINARY STRUCTURE BLADDER – BAG COMPOSED OF SMOOTH MUSCLE FORMS DETRUSOR MUSCLE UROEPITHELIUM – INTERFACE BETWEEN URINARY SPACE AND VASCULATURE, NERVES, MUSCLES TRIGONE – SMOOTH, “TRIANGULAR” AREA BETWEEN OPENING OF URETERS  URINARY STRUCTURES URETHRA INTERNAL SPHINCTERS SMOOTH MUSCLE LOCATED AT JUNCTION OF BLADDER AND URETHRA EXTERNAL SPHINCTER STRIATED SKELETAL MUSCLE UNDER VOLUNTARY CONTROL BETWEEN 3 AND 4 CM LONG IN FEMALES BETWEEN 18 AND 20 CM LONG IN MALES BLADDER INNERVATION INNERVATION PARASYMPATHETIC FIBERS BLADDER AND INTERNAL URETHRAL SPHINCTER BLADDER CONTRACTION AND URINE EMPTYING SOMATIC MOTOR NEURONS IN THE PUDENDAL NERVE EXTERNAL URETHRAL SPHINCTER WHEN BLADDER IS DISTENDED TO 150-250 ML URINE, SENSATION OF FULLNESS IS TRANSMITTED TO SPINAL CORD – CEREBRAL CORTEX 400-500 ML PERSON WILL SENSE FULLNESS  CONGENITAL ABNORMALITIES IN MALES HYPOSPADIAS URETHRAL MEATUS IS LOCATED ON THE VENTRAL SIDE OR UNDERSURFACE OF THE PENIS. MOST COMMON ANOMALY EPISPADIAS MALES: URETHRAL OPENING IS ON THE DORSAL SURFACE OF THE PENIS.  LIFESPAN CONSIDERATIONS NEWBORNS SCHOOL-AGE CHILDREN LIMITATIONS REGARDING CONCENTRATION, DILUTION KIDNEYS DOUBLE IN SIZE BETWEEN THE AGES OF 5 IMPORTANT IN MONITORING FOR DEHYDRATION, AND 10 OVERHYDRATION CHILD URINATES 6 TO 8 TIMES PER DAY IMPORTANT TO ENSURE THAT NEWBORN VOIDS WITHIN ENURESIS IS COMMON 48 HOURS AFTER DELIVERY PATTERNS OF VOIDING: MORE FREQUENT DIURNAL ENURESIS MAY BE PATHOLOGIC URINE MAY BE CLOUDY IN NEWBORN, STRAW-COLORED NOCTURNAL ENURESIS (BEDWETTING) IN EARLY INFANCY PREVALENT IN DEEP SLEEPERS TODDLERS AND PRESCHOOLERS NOT A PROBLEM UNTIL AFTER 7 YEARS OF AGE MOST DEVELOP URINARY CONTROL BETWEEN 2 AND 5 YEARS OF AGE CONTROL DURING DAYTIME NORMALLY PRECEDES NIGHTTIME CONTROL REQUIRE REMINDERS ON FLUSHING, HANDWASHING REQUIRE INSTRUCTION IN WIPING  LIFESPAN CONSIDERATIONS PREGNANT WOMEN ENLARGING UTERUS PRESSES AGAINST THE BLADDER, INCREASING URINARY FREQUENCY SYMPTOM DECREASES DURING SECOND TRIMESTER REAPPEARS DURING THIRD TRIMESTER POSTPARTUM: RISK FOR OVER DISTENTION, INCOMPLETE BLADDER EMPTYING, RESIDUAL URINE URINARY TRACT INFECTION (UTI) RISK URINARY OUTPUT INCREASES IN EARLY POSTPARTUM PERIOD  AGING ADULT URINE MORE DILUTE INCREASED BLADDER SYMPTOMS LIFESPAN URGENCY, FREQUENCY, NOCTURIA FREQUENT NIGHTTIME AWAKENINGS TO EMPTY CONSIDERATI BLADDER ONS UPPER URINARY TRACT OBSTRUCTIONS BLOCKAGE OF URINE FLOW WITHIN THE URINARY TRACT OBSTRUCTION CAN BE CAUSED BY AN ANATOMIC OR A FUNCTIONAL DEFECT. SEVERITY IS BASED ON LOCATION COMPLETENESS INVOLVEMENT OF ONE OR BOTH UPPER URINARY TRACTS DURATION NATURE AND/OR CAUSE KIDNEY/URINARY STONES RENAL CALCULI  DESCRIPTION MOST COMMON CAUSE OF UPPER URINARY TRACT OBSTRUCTION MOST STONES DEVELOP IN KIDNEYS AND MIGRATE INTO URINARY STRUCTURES STONES COMPOSED OF VARIOUS ORGANIC AND NONORGANIC COMPOUNDS TYPES OF STONES CALCIUM - *MOST COMMON URIC ACID - *2ND MOST COMMON STUVITE – FOUND MOSTLY IN PEOPLE WITH URINARY TRACT INFECTIONS CYSTINE – CAUSED BY GENETIC DISORDER WHERE THERE IS A BUILD UP OF CYSTINE (ACID) LEAKS FROM KIDNEY INTO URINE TABLE 33-2 PORTH  ETIOLOGY NON-MODIFIABLE MODIFIABLE AGES 20-50 DEHYDRATION PERSONAL OR FAMILY HX DIET HIGH IN PROTEIN, SALT OR OBESITY GLUCOSE HYPERPARATHYROID MEDICATIONS – DIURETICS, INFLAMMATORY BOWEL DISEASE ANTISEIZURE DRUGS, CALCIUM BASED ANTACIDS GOUT PATHOPHYSIOLO GY STONE FORMATION REQUIRES: 1. SUPERSATURATED URINE 2. ENVIRONMENT OPTIMAL FOR GROWTH SUPERSATURATION DEPENDS ON: URINARY PH TEMPERATURE SOLUTE CONCENTRATION IONIC STRENGTH NIDUS (NUCLEUS) THAT FACILITATES CRYSTAL AGGREGATION CLINICAL MANIFESTATIO NS SYMPTOMS DO NOT TYPICALLY APPEAR UNTIL STONE TRAVELS DOWN THE URETER SEVERE PAIN IS CALLED RENAL COLIC CAN RADIATE TO GROIN IN MEN  LIFESPAN CONSIDERATIONS Many people Some people experience have natural supersaturated stone inhibitors urine and don’t like magnesium develop stones and citrate  DIAGNOSIS URINALYSIS (UA) – DETECT PRESENCE OF HEMATURIA, INFECTION, PRESENCE OF STONE CRYSTALS AND URINE PH. RADIOGRAPHY (XRAY) – MOST STONES ARE RADIOPAQUE ABDOMINAL ULTRASOUND  TREATMENT PREVENTION TREATMENT AVOID SODA SUPPORTIVE CARE – PAIN RELIEF ADEQUATE WATER INTAKE (8-12 GLASSES) TREAT UNDERLYING CAUSE: CITRUS JUICES ANTIBIOTICS FOR UTI CALCIUM-RICH FOODS (BIND WITH THE OXALATE IN FOOD) ALLOPURINOL FOR GOUT LIMIT ANIMAL PROTEIN SOURCES MAY PASS SPONTANEOUSLY IF SMALL LESS SALT, SUGAR, OR HIGH FRUCTOSE CORN SYRUP LITHOTRIPSY – BUST UP CRYSTAL INTO SMALL AVOID DEHYDRATING LIQUIDS (CAFFEINE, ALCOHOL) FRAGMENTS TO PASS LIMIT VIT C INTAKE URINE SHOULD BE STRAINED DURING AN ATTACK TO CATCH THE STONES FOR EVALUATION LOWER URINARY TRACT OBSTRUCTION RELATED TO STORAGE OF URINE IN THE BLADDER OR EMPTYING OF URINE THROUGH BLADDER OUTLET CAUSES: NEUROGENIC OR ANATOMIC ALTERATIONS – CAN BE COMBINATION OF BOTH INCONTINENCE IS PRIMARY SYMPTOM  INVOLUNTARY LEAKAGE OF URINE URINARY SPHINCTER CONTROL IS LOST OR WEAK RISK FACTORS: MULTIPARTY INCONTINEN OBESITY CE GENDER – DEPENDS ON TYPE OF INCONTINENCE AGE PROSTATE DISEASE COMORBID CONDITIONS SMOKING  TYPES OF INCONTINENCE INVOLUNTARY LOSS OF URINE…. STRESS: INVOLUNTARY LOSS OF URINE DURING COUGHING, SNEEZING, LAUGHING, OR PHYSICAL ACTIVITY URGE: ABRUPT AND STRONG DESIRE TO VOID; OVERACTIVITY OF DETRUSOR MUSCLE OVERFLOW: OVERDISTENTION OF BLADDER D/T ENLARGED PROSTATE OR OTHER OBSTRUCTION; BLADDER PRESSURE EXCEEDS MAX URETHRAL PRESSURE IN THE ABSENCE OF DETRUSOR ACTIVITY NEUROGENIC: IMPAIRED FUNCTION OF NEURO SYSTEM; SPINAL CORD INJURY FUNCTIONAL: LACK OF COGNITIVE FUNCTION TO GO TO THE BATHROOM CAUSED BY DEMENTIA OR IMMOBILITY  INVOLUNTARY PASSAGE OF URINE BY A CHILD WHO IS BEYOND THE AGE WHEN VOLUNTARY BLADDER CONTROL SHOULD HAVE BEEN ACQUIRED 5 YEARS OLD NOCTURNAL ENURESIS (BEDWETTING) PREVALENT IN DEEP SLEEPERS NOT A PROBLEM UNTIL AFTER 7 YEARS OF AGE CLINICAL MANIFESTATIONS PRIMARY ENURESIS: CHILD HAS NEVER BEEN CONTINENT. SECONDARY ENURESIS: CHILD WAS CONTINENT BUT URINARY IS NOW INCONTINENT. INCONTINEN CE IN DIURNAL, NOCTURNAL, OR BOTH NEED TO ELIMINATE ORGANIC, BEHAVIORAL, OR PHYSIOLOGIC CAUSES BEFORE EXPLORING PSYCHOLOGIC CHILDREN  DIAGNOSIS & TREATMENT NOT ACTUALLY A DISEASE, BUT A SYMPTOM FROM MANY CAUSES MUST INVESTIGATE THE CAUSE TREATMENT DEPENDS ON TYPE OF INCONTINENCE, COMORBIDITIES, AND AGE BEHAVIORAL MEASURES, PHARMACOLOGIC MEASURES, SURGICAL CORRECTION BEHAVIORAL MEASURES: FLUID MANAGEMENT, TIMED VOIDING, PELVIC FLOOR EXERCISES, BLADDER RETRAINING, TOILETING ASSISTANCE  SPECIAL CONSIDERATIONS Common problem in older adults Associated with social isolation, institutionalization, predisposition to infection & skin breakdown Medications prescribed for other health problems may contribute to issues URINARY TRACT INFECTIONS DESCRIPTION FREQUENT TYPE OF BACTERIAL INFECTION CLASSIFICATIONS: ASYMPTOMATIC BACTERIURIA SYMPTOMATIC INFECTION LOWER UTI – CYSTITIS UPPER UTI – PYELONEPHRITIS (MORE SERIOUS)  ETIOLOGY MOST LOWER, UNCOMPLICATED UTI CAUSED BY E. COLI COMPLICATED UTI CAUSED BY KLEBSIELLA PNEUMONIAE, ENTEROCOCCUS FAECALIS, PSEUDOMONAS AERUGINOSA WOMEN MORE AT RISK THAN MEN – URETHRA LENGTH, PROSTATE FLUID WHEN UTI OCCURS THE BACTERIA HAVE USUALLY COLONIZED THE URETHRA, VAGINA, OR PERIANAL AREA RISK FACTORS: PRIOR UTI, SEXUAL ACTIVITY WITH NEW PARTNER, CHANGES IN VAGINAL FLORA OR PH OTHER RISK FACTORS: INDWELLING CATHETERS IMMUNOCOMPROMISED GROUPS  Urine is normally sterile and washes out distal urethra NATURAL Bladder lining provides a barrier to HOST protect against bacterial invasion DEFENSE Immune response S Host microflora  PATHOPHYSIOLOGY VIRULENCE FACTORS (REFER BACK TO INFECTION) HELP MICROORGANISMS EVADE THE HOST DEFENSES AND PRODUCE DISEASE OBSTRUCTION AND REFLUX ARE CONTRIBUTING FACTORS HOLDING YOUR BLADDER – STASIS OF URINE FLOW, INCREASED BLADDER PRESSURE LEADS TO DECREASE IN MUCOSAL DEFENSE BACKFLOW OF URINE FROM BLADDER TO URETHRA – ACTIVITIES SUCH AS COUGHING OR SQUATTING CAUTI – CATHETER ASSOCIATED UTI – MOST FREQUENT CAUSE OF GRAM – INFECTIONS IN THE HOSPITAL SETTING  Depends if lower (bladder) or upper (kidney) are involved CLINICAL MANIFESTATIO NS Bladder infection (uncomplicated) Lower Cloudy Burning and Urinary abdominal or and/or foul- pain on frequency back smelling urination discomfort urine  LIFESPAN CONSIDERATIONS Children Pregnancy Elderly More frequent in boys 3 mo. anatomic and physiologic infection changes Generally involve upper Displaced organs Decreased immune urinary tract in infancy Hormone changes function, immobility, outflow obstruction, decreased perfusion, stones, Atypical signs: may present May often be asymptomatic Varying symptoms – with bacteremia & signs of asymptomatic to typical septicemia (fever, Could lead to preterm signs hypothermia, poor delivery perfusion, lethargy, Difficult to interpret – often irritability) Routine screening already have issues with Feeding issues, failure to recommended during 1st frequency, urgency or thrive and 3rd trimesters incontinence  Urinalysis & urine culture History of voiding patterns, DIAGNOSI symptoms S AND Antibiotics TREATME NT Rehydration Treat symptoms: AZO (Phenazopyridine) QUESTIONS?